With an estimated 20,000 people attending, the 2008 International AIDS Conference in Mexico City had the potential to be more theater than science. Yet in session after session delegates brought up health workforce as the main obstacle to the implementation of their programs. HIV testing couldn’t be done due to lack of counselors and laboratory technicians. Generational transmission from a mother to her child could not be prevented due to a lack of midwives to administer antiretrovirals during labor. Drugs sit on shelves while people die from lack of nurses and physicians to prescribe the drugs and manage the therapy and its side effects.
This interest was reflected in the attendance of over 300 people at the Global Health Workforce Alliance’s (http://www.who.int/workforcealliance/en/) session on the global health worker shortage (http://www.aids2008.org/Pag/PSession.aspx?s=15). I had the opportunity to present on the cost-effectiveness of task-shifting, a team approach to HIV/AIDS treatment and care. In the light of the massive scale up of health workforce, whether for AIDS or other killers,
Over the past year the dialogue on the heath worker shortage has evolved and grown more sophisticated. Gone is the chauvinism toward mid-level and front-line health workers. Medical officers and nurse practitioners are now being embraced for their history of providing high quality care in rural areas. Community Health Workers are emerging as the first line in prevention treatment and care. Gone are the across the board calls for wage increases of health workers who are amongst the top 10% of wage earners in their country. This is replaced by an understanding that incentives for health workers to stay in country need to be rationally designed and evidence-based. HIV/AIDS program managers are now calling for practical recommendations and guidelines on how to rapidly train and retain workers and improve the quality of the care they deliver.
The proof of the health workforce commitments generated in Mexico City will be revealed over the next year as major donors make decisions on AIDS and other health investments. Will they deliver?